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Management of Maternal Cardiac Arrest by Anesthesiology Residents: Evaluation of a Crisis Checklist in Anesthesia Simulation-Based Training
Abstract Number: F 10
Abstract Type: Original Research
Maternal cardiac arrest (MCA) is a rare but devastating event, and immediate advanced cardiac life support (ACLS) with necessary modifications for pregnancy is critical. Teaching anesthesia trainees how to manage this high acuity, low frequency event may be enhanced by simulation based-technology. The use of a checklist for simulated operating room crises improves management (1), but this has yet to be demonstrated in obstetric crisis training. Our objective was to evaluate the impact of checklist use by anesthesia residents for the management of a simulated MCA. Knowledge acquisition, retention and self-evaluation were also compared.
Anesthesia residents were randomized to control or intervention groups. All participants completed a multiple choice MCA baseline knowledge test then received a standardized 15-minute didactic lecture on management of MCA. The intervention group was then introduced to a MCA checklist, and the control group was not. Within a week, the participants managed a videotaped MCA scenario at our simulation center. All participants received standard debriefing and completed a written self-assessment and feedback form. A week later, participants completed a MCA knowledge post-test. Videos were scored by two blinded independent raters for performance of technical and non-technical Results
Nine anesthesia residents have been recruited to date. Results are shown in the Table. Residents in the checklist group performed superiorly in all skills and had a shorter time to perimortem cesarean delivery. Residents uniformly valued the simulator experience, and those in the checklist group found the checklist to be helpful both before and during the simulation. Based on self-assessment scales, there was no difference between groups regarding acquired confidence to recognize and manage MCA.
High-fidelity simulation training for obstetric emergencies provides a valuable platform to evaluate and modify crisis checklists. The use of a checklist by anesthesia residents in simulated scenarios of MCA had significant impact on completion of essential technical tasks, with a less substantial but notable improvement in nontechnical tasks as well.
1.Arriaga AF et al. N Engl J Med. 2013;17;368(3):246-53
2.Hards A et al. Can J Anaesth. 2012;59(9):852-60
3.Ziewacz JE et al. J Am Coll Surg. 2011; 213(2):212-217